Why don't some like the fire mix?

[JWalters]

I have noticed a few people on here say that they feel that fire and EMS should not be mixed, in terms of being a ff and an EMT/P. I'm curious as to why. Or if you think they are a great mix, I'd like to know why you feel that way as well.

I was thinking of joining our FD and doing the state FF 1/2 training but my primary focus, over the next couple year, is getting through a medic program.

 

[ghost02]

I don't go to home depot for computers.

 

[JWalters]

I don't go to home depot for computers.

Well, me either.

Ok, to be more specific...I've seen people flat out say that they think having both an EMT cert as well as a FF cert is a bad idea. Where I live, all of our municipal ambulances are run out of FD's. I'm just curious as to what is so "bad" about it, especially if you live in an area where the EMS/FD often is run under one direction. I see it as a way to make a greater contribution to my community....or maybe I am just delusional. That is entirely possible.

 

[sjukrabilalfur]

Just a small-sample anecdote.

When I was a student and doing clinicals with [unnamed urban midwestern fire/rescue service], the FF/Medics all vastly preferred being on the pumper to being assigned to the ambulance. They seemed like cool guys, and they weren't derelicts on the ambulance, but they treated it as a chore, or just something they just sort of had to do to get to their next pumper shift and it showed in how they handled their calls. I don't know if that's indicative of how all FF/Medics approach the ambulance side, but if it is, I'd rather the services be separated.

 

[avdrummerboy]

^^^^^ THAT ^^^^^

Most guys that I know that go fire do it because they want to be the hero firefighter guy fighting fires and cutting things apart, most see running med aid calls as just a chore, something that has to be done because they are told to do it. My belief, at least where I'm at, fire dept. should be FF/ First responder trained, and respond only to fire/ rescue calls, not every call that goes out!

 

[JWalters]

Interesting. Yeah, I can see why people would feel that way if these were their experiences.

 

[MrJones]

The individual-level issues are summarized nicely above. At the organizational level, too many fire departments use the EMS side to justify their budgets, yet the EMS side usually endures second-hand citizen status. At some point the IAFC will have to accept the obvious and direct that dual services be referred to as EMS-based fire services.

 

[chaz90]

I believe in becoming truly proficient at one skill rather than passable at two. I think some can become competent in both, but the majority are only really interested in doing one and are thus a liability while functioning in the other role despite what their PR machine says. I don't want a paramedic forced to be a firefighter coming in to my burning house, and I don't want a firefighter forced to be a paramedic treating my critically ill grandmother.

My caveat to that is I don't always disagree to FF training to a BLS level and first responding on certain calls. All ALS care (true paramedic level) though should be provided by a dedicated single role provider.

 

[Rialaigh]

I find that most people that express "dislike" for the ff/ems mix may have a valid reason or two to have that dislike but generally have a dozen reasons that just don't make sense.

From the vast majority of budget, management, and training standpoints it makes a lot of sense to combine the two entirely. From a call numbers stand point it makes sense to combine the two. From almost all tangible measurements it makes sense to run the two as one service.

Unless EMS can quickly and effectively transition into prehospital community medicine and show value in that I think fire based EMS will become more prevalent very rapidly. Even if EMS transitions into community paramedicine effectively I am not so sure that the 911 portion wouldn't be better managed as a combined EMS/Fire service and that paramedics working prehospital community paramedicine would function better working directly with hospitals as opposed to their EMS services.

 

[JPINFV]

I don't want a plumber practicing medicine.

 

[Handsome Robb]

Some might not think it's a valid reason but we're one of if not the only nations that combines EMS and Fire and have one of the worst EMS systems of "first world" countries.

Don't get me wrong, some FDs do EMS very well but it is not the norm.

 

[TransportJockey]

Some might not think it's a valid reason but we're one of if not the only nations that combines EMS and Fire and have one of the worst EMS systems of "first world" countries.

Don't get me wrong, some FDs do EMS very well but it is not the norm.

We also have the lowest standards of entry into the field of any of the developed countries. There's a reason us ems is looked down on

 

[MrJones]

I find that most people that express "dislike" for the ff/ems mix may have a valid reason or two to have that dislike but generally have a dozen reasons that just don't make sense.

From the vast majority of budget, management, and training standpoints it makes a lot of sense to combine the two entirely. From a call numbers stand point it makes sense to combine the two. From almost all tangible measurements it makes sense to run the two as one service.

Unless EMS can quickly and effectively transition into prehospital community medicine and show value in that I think fire based EMS will become more prevalent very rapidly. Even if EMS transitions into community paramedicine effectively I am not so sure that the 911 portion wouldn't be better managed as a combined EMS/Fire service and that paramedics working prehospital community paramedicine would function better working directly with hospitals as opposed to their EMS services.

And I find that most people that express "like" for the FF/EMS mix are either FFs for whom becoming an EMT or Medic was the cost of admission to join their local fire department or fire department leaders who are riding the back of EMS to keep their departments solvent.

Makes sense from a budget, management and training standpoint? Show me a study not sponsored by the IAFF, IAFC or any other entity with a vested interest in the fire side that demonstrates that to be the case. From a call numbers stand point? Only if you are using EMS calls, which now typically account for upwards of 80% of a Fire/EMS system's calls, to justify the budget for the fire side of the system. Almost all tangible measurements? What other measurements are there that might make your case?

Ultimately, the only measurement that truly matters is the level of care provided by a system and that is a direct measure of the competence (which is the sum of the education, training and experience) of the EMTs and Paramedics providing that care. Prove to me - empirically, not anecdotally - that the typical fire system provides a higher level of care than a typical third service and you might convince me. Otherwise, your simply regurgitating IAFF/IAFC propaganda.

/soapbox

 

[Rialaigh]

And I find that most people that express "like" for the FF/EMS mix are either FFs for whom becoming an EMT or Medic was the cost of admission to join their local fire department or fire department leaders who are riding the back of EMS to keep their departments solvent.

Makes sense from a budget, management and training standpoint? Show me a study not sponsored by the IAFF, IAFC or any other entity with a vested interest in the fire side that demonstrates that to be the case. From a call numbers stand point? Only if you are using EMS calls, which now typically account for upwards of 80% of a Fire/EMS system's calls, to justify the budget for the fire side of the system. Almost all tangible measurements? What other measurements are there that might make your case?

Ultimately, the only measurement that truly matters is the level of care provided by a system and that is a direct measure of the competence (which is the sum of the education, training and experience) of the EMTs and Paramedics providing that care. Prove to me - empirically, not anecdotally - that the typical fire system provides a higher level of care than a typical third service and you might convince me. Otherwise, your simply regurgitating IAFF/IAFC propaganda.

/soapbox

This is flat out not even close to the only measurement that matters. The goal is ultimately a higher level of care but the costs associated with that are very important. Making a blanket statement like "better care at any cost" is just not an appropriate or responsible way to look at healthcare of any level.

I do not at the moment have the time to respond in full but I will be more then happy to discuss this later tonight when I have the time to put together a well thought out post.

 

[MrJones]

This is flat out not even close to the only measurement that matters. The goal is ultimately a higher level of care but the costs associated with that are very important. Making a blanket statement like "better care at any cost" is just not an appropriate or responsible way to look at healthcare of any level.

I do not at the moment have the time to respond in full but I will be more then happy to discuss this later tonight when I have the time to put together a well thought out post.

Feel free to put together a well thought out post, but I've made my point and I stand by it.

 

[SandpitMedic]

An intelligent debate is about to be had.


(Back to the peanut gallery)

 

[Rin]

FD's are still fairly homogenous. Many are still good ol' boys clubs. Friends with the mayor/chief/etc? Welcome to the head of the hiring line. Female? Good luck with that dual role. There will always be 50 guys bigger and stronger than you who are better suited to pulling people out of structure fires.

This is especially problematic in multicultural areas. When all your FF brothers are like you, but the patients you respond to are poor people/females/minorities having a bad day, it only nurtures the little prejudices lurking in your mind.

This can impact the conclusions reached from assessment of those patients, and the treatment of those patients, especially by lazy or reluctant providers eager to get back to fooling around at the station.

Female patients can also be reluctant to share embarrassing medical details with men, especially if the men are young, especially if they show up with half a dozen male crew members (as happens in places that have a pumper also respond).

FireEMS is ultimately a concept that's only good on paper. You can't ignore the human factor in a business that's all about people.

 

[46Young]

Just a small-sample anecdote.

When I was a student and doing clinicals with [unnamed urban midwestern fire/rescue service], the FF/Medics all vastly preferred being on the pumper to being assigned to the ambulance. They seemed like cool guys, and they weren't derelicts on the ambulance, but they treated it as a chore, or just something they just sort of had to do to get to their next pumper shift and it showed in how they handled their calls. I don't know if that's indicative of how all FF/Medics approach the ambulance side, but if it is, I'd rather the services be separated.

I did my first five years a tiered single role EMS system. Back then, I was 100% about EMS, and had no doubt that I wanted to be on the street for 20-30 years doing ALS 911 txp. Then, the job started getting to me - having to post on street corners, no sleep or downtime, mandatory forced OT, constantly interrupted meals (sitting down for dinner three times and still not eating - that type of thing), and people calling for every little thing (missed lunch to run a call for a kid with head lice once), and most importantly, for not enough money. There's also the boredom/frustration factor that there's no realistic career ladder, so street EMS txp is really the only thing most of us could do for their entire career.

So, I went to fire based EMS. At that time, being a medic was what I still liked doing the most, but fire had interested me for some time. The real reason for the jump was because I needed to do something different than just ambulance txp day in and day out, with better benefits and pay. So, it becomes frustrating when you want to do more than just transport, but keep getting moved back to the ambulance repeatedly. After some time, you just get tired of wasting your time running non-acute calls, missing drills, meals, PT, and sleep. The engine is back in service in 20 minutes, but if you're transporting, you know that it's going to be an hour to an hour and a half until you can get back to the station, if you can avoid a second call on the road. I think that it's the lack of relative downtime that breeds resentment towards ambulance work. There are many other medics like me that started single role and then went fire. They all say that they would never go back to single role. They also all say that at one time they liked being medics, but that it was beat out of them by having to ride the ambulance most of the time, typically running people all day and night with minor issues that don't really need an emergency room. There's also the QA/QI thing - medics on the ambulance have much, much more to worry about than someone who rides backwards on the engine.

More or less, I feel the same way as these other dual role medics. I get a good ALS call once in a blue, and I truly enjoy those type of calls, but I have no use for the 90%+ mundane calls that keep us out of the station all day. As a result, I prefer to be off of the ambulance as much as possible, to do other things and once again look forward to coming to work. The good calls are too infrequent to make it worth it to do a tour on an ambulance - we're an all-ALS txp system, so we run everything. It's a lousy feeling to be taking a beating on the ambulance day in and day out when everyone else in the station gets to go back in service, enjoy downtime, and get things done throughout the day. I've seen some hardcore medics grow to resent the ambulance for these reasons.

Also, let's not forget that even in single role EMS, there are plenty of people that resent ambulance txp. EMS is a stepping stone job for a lot of people, because it pays well enough to pay for room and board while they work towards a better career. Average single role EMS burnout is 7-10 years for a reason. This resentment and burnout is hardly just a fire service thing. It's just that in the fire service, there's other paths to choose to get out of txp. Resentment develops when the employee is denied the opportunity to pursue those paths.

 

[BEN52]

I would like to add a couple of points here based upon my experience working in a variety of systems; full time fire based EMS, private contract EMS, and muncipal third service as well as an ER paramedic in a facility greeting EMS providers from all types of systems.

First and foremost there are bad providers in all systems, nobody is immune. Secondly it seems to me that third service systems are judged based upon there shining stars such as Wake County and Austin / Travis County whereas fire based systems are judged upon the systems generating negative press.

For many suburban communities fire based ems makes sense because it allows for properly staffed fire and ems response. If they where to be seperate im not sure the money would be there. The paid fire service has established funding mechanisms in place. EMS as a whole does not.

As a provider who likes both disciplines but would pick EMS if I could only pick one I chose fire based EMS because it offers a stable and well compensated career with legitimate upward mobility. There are not many EMS only gigs that will pay me a nice salary with a sound pension and good benefits. I work 8-9 days a month and make north of 70k a year with a 25 year pension. As a family man that is important. As a provider I work out of a comftorable station with clean and ample living quarters, laundry facilities, a fully equiped kitchen, and an ample weight room. This may not seem like much but none of my EMS only jobs had this. I spend my downtime in comfort as opposed to a street corner. I am given safe and modern equipment. My agency has a pretty decent in house EMS training program in conjunction with our medical control hospital. I am also offered the opportunity to attend just about any outside training course free of charge and on the clock.

 

[vcuemt]

I would like to add a couple of points here based upon my experience working in a variety of systems; full time fire based EMS, private contract EMS, and muncipal third service as well as an ER paramedic in a facility greeting EMS providers from all types of systems.

First and foremost there are bad providers in all systems, nobody is immune. Secondly it seems to me that third service systems are judged based upon there shining stars such as Wake County and Austin / Travis County whereas fire based systems are judged upon the systems generating negative press.

For many suburban communities fire based ems makes sense because it allows for properly staffed fire and ems response. If they where to be seperate im not sure the money would be there. The paid fire service has established funding mechanisms in place. EMS as a whole does not.

As a provider who likes both disciplines but would pick EMS if I could only pick one I chose fire based EMS because it offers a stable and well compensated career with legitimate upward mobility. There are not many EMS only gigs that will pay me a nice salary with a sound pension and good benefits. I work 8-9 days a month and make north of 70k a year with a 25 year pension. As a family man that is important. As a provider I work out of a comftorable station with clean and ample living quarters, laundry facilities, a fully equiped kitchen, and an ample weight room. This may not seem like much but none of my EMS only jobs had this. I spend my downtime in comfort as opposed to a street corner. I am given safe and modern equipment. My agency has a pretty decent in house EMS training program in conjunction with our medical control hospital. I am also offered the opportunity to attend just about any outside training course free of charge and on the clock.

I think you're illustrating the points of those who are anti-fire-based-EMS.